THE ROLE OF ESTROGEN AND PROGESTERONE RECEPTORS IN THE PATHOGENESIS OF ADENOMYOSIS IN COMBINATION WITH ENDOMETRIAL HYPERPLASIA IN POSTMENOPAUSAL PERIOD

Objective. The establishment of the role of estrogen (ER) and progesterone (PR) receptors in the pathogenesis of adenomyosis (AM) in combination with endometrial hyperplasia (EH) in postmenopausal women. Materials and methods. 18 cases of AM with the presence of EH in patients aged 51-70 years have been inves-tigated based on the pathological laboratory of the Center for Reconstructive and Restorative Medicine (University Clinic) of Odesa National Medical University. Selection Criteria: Morphologically verified diagnosis of AM, post menopause (no menstruation for more than a year), and the presence of EH. Immunohistochemical (IHC) studies of ER and PR were performed to determine the state of the receptor apparatus of the eu- and ectopic endometrium. Immunohistochemical reaction was performed using monoclonal murine antibodies of estrogen receptor alpha (clone SR1) and progesterone antibodies (clone YR85). Expression of markers for estrogen and progesterone was evaluated according to the presence of the IHC reaction and degree of severity. Results. Steroid dependence of endometrial com-ponents both eutopic with EH and ectopic in AM foci is established. The epithelial component of the eutopic endometrium with EH was characterized by pronounced ER receptor activity in most cases - in 11 of 18 women. PR glandular cells exhibited moderate and pronounced expressive activity. In stromal cells of the endometrium with EH, mod-erate and high expressions of ER expression were detected. PR showed a high prevalence rate (15 of 18 cases). The weakness or absence of the IHC reaction was not detected in any case at all. The highest expression of ER and PR in the stroma of the eutopic endometrium was observed in simple and complex forms of EH without atypia. The IHC reaction in endometrium with atypical EH was less pronounced and was accompanied by a decrease in both groups of receptors. In the foci of endometrioid heterotopy, moderate progesterone activity of the receptor apparatus was observed both in the stroma and in the glands in the majority of patients (in 12 of 18 women) and only in six cases it was expressed. Epithelial cells of the pathological foci were characterized by decreased expression of ER. Significant differences in the activity of the receptor apparatus of the stroma and glands constituents, both of eu- and ectopic endometria, between the forms of non-atypical EH were not detected. The atypical form of EH was characterized by predominantly moderate and weak activity of the eutopic endometrium ER on the background of moderate IHC of the PR response. The predominance of expressive ER activity over PR in the endometrium with non-atypical EH is established. In women with atypical EH, the predominantly opposite situation was observed. In the epithelial cells of AM foci, the majority of observations revealed a predominance of PR over ER (ER / PR <1). The uniform distribution of the number of cases by the phenotypic variants of the ratio of ЕR and РR is charac-teristic of cells of the endometrial stroma. Conclusions. Positive estrogen and progesterone activity of the receptor apparatus is pathogenetically important for AM and EH. The level of expression of ЕР and РR decreases with the progression of EH (from non-atypical to atypical). Atypical EH is less hormonal-dependent pathology than non-atypical one. The positive expressive reaction of a sufficient amount of ER and PR and the presence of the ratio of ER / PR <1 in the endometrioid foci play a key role in the pathogenesis of AM.